AsiaIntervention最新文献

Background: The effect of 3D-printed bioresorbable vascular scaffolds (BRS) in coronary heart disease has not been clarified.

Aims: We aimed to compare the safety and efficacy of 3D-printed BRS with that of metallic sirolimus-eluting stents (SES).

Methods: Thirty-two BRS and 32 SES were implanted into 64 porcine coronary arteries. Quantitative coronary angiography (QCA) and optical coherence tomography (OCT) were performed at 14, 28, 97, and 189 days post-implantation. Scanning electron microscopy (SEM) and histopathological analyses were performed at each assessment.

Results: All stents/scaffolds were successfully implanted. All animals survived for the duration of the study. QCA showed the two devices had a similar stent/scaffold-to-artery ratio and acute percent recoil. OCT showed the lumen area (LA) and scaffold/stent area (SA) of the BRS were significantly smaller than those of the SES at 14 and 28 days post-implantation (14-day LA: BRS vs SES 4.52±0.41 mm² vs 5.69±1.11 mm²; p=0.03; 14-day SA: BRS vs SES 4.99±0.45 mm² vs 6.11±1.06 mm²; p=0.03; 28-day LA: BRS vs SES 2.93±1.03 mm² vs 4.82±0.74 mm²; p=0.003; 28-day SA: BRS vs SES 3.86±0.98 mm² vs 5.75±0.71 mm²; p=0.03). Both the LA and SA of the BRS increased over time and were similar to those of the SES at the 97-day and 189-day assessments. SEM and histomorphological analyses showed no significant between-group differences in endothelialisation at each assessment.

Conclusions: The novel 3D-printed BRS showed safety and efficacy similar to that of SES in a porcine model. The BRS also showed a long-term positive remodelling effect.

Background: A novel quantitative flow ratio (μQFR) for bifurcated coronary vessels, derived from a single projection, has been recently reported. Provisional stenting is effective for most bifurcation lesions. However, the clinical value of the side branch (SB) μQFR in patients with coronary bifurcation lesions undergoing provisional stenting remains unclear.

Aims: This study aims to determine the clinical predictive value of the SB μQFR after provisional stenting in patients with coronary bifurcation lesions.

Methods: Between June 2015 and May 2018, 288 patients with true coronary bifurcation lesions who underwent a provisional approach without SB treatment (including predilation, kissing balloon inflation or stenting) were classified by an SB μQFR <0.8 (n=65) and ≥0.8 (n=223) groups. The primary endpoint was the three-year composite of target vessel failure (TVF), including cardiac death, target vessel myocardial infarction (TVMI), and revascularisation (TVR).

Results: Three years after the procedures, there were 43 (14.9%) TVFs, with 19 (29.2%) in the SB μQFR <0.8 and 24 (10.8%) in the SB μQFR ≥0.8 groups (adjusted hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.39-5.54; p=0.003), mainly driven by increased TVMI (16.9% vs 5.4%, adjusted HR 3.29, 95% CI: 1.15-6.09; p=0.030) and TVR (15.4% vs 2.2%, adjusted HR 6.39, 95% CI: 2.04-13.48; p=0.007). Baseline diameter stenosis at the ostial SB and SB lesion length were the two predictors of an SB μQFR <0.8 immediately after stenting the main vessel, whereas previous percutaneous coronary intervention and an SB μQFR <0.8 were the two independent factors of 3-year TVF.

Conclusions: An SB μQFR <0.8 immediately after the provisional approach is strongly associated with clinical events. Further randomised studies with large patient populations are warranted.

Background: The concept of three-dimensional (3D) wiring for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is now widely accepted among coronary interventionalists. The 3 axes, i.e., the 2 X-ray beams and the CTO segment, should intersect with each other at as close to a right angle as possible. However, how to specify optimal fluoroscopic angulations for a given CTO segment has not been well established.

Aims: We aimed to develop a simple and practical method to identify optimal fluoroscopic angulations for CTO PCI.

Methods: A CTO vector can be derived from slab maximum intensity projection (MIP) images of coronary computed tomography (CT) angiography. Using trigonometric functions, the inner product of vectors and the equation of a plane, we calculated 2 fluoroscopic vectors perpendicular to each other and to the CTO vector.

Results: We applied this method to a patient with mid-left circumflex CTO and translated the resulting fluoroscopic vectors into optimal fluoroscopic angulations. To facilitate its use, we developed a calculator using spreadsheet software that can output optimal fluoroscopic angulations within a practical range by inputting the x, y, and z components of the CTO vector. This approach also helps to minimise dead angles in biplane fluoroscopy.

Conclusions: This method has the potential to make CTO PCI safer and easier, without requiring dedicated equipment or software. Its effectiveness should be validated in clinical practice.

Background: Coronary cannulation after TAVR is sometimes difficult due to an overlap between native and neo-commissures, especially in Evolut devices with a supra-annular position. The Evolut C-tab corresponds to a neo-commissure, and the hat marker is in a fixed position. Therefore, the orientation of the hat marker can be adjusted to minimise overlaps.

Aims: We investigated whether the HAt marker-guided SHaft rotation method (HASH, stylised as the #rotation method) is effective in facilitating coronary artery access after transcatheter aortic valve replacement (TAVR) with an Evolut system.

Methods: We retrospectively analysed 95 patients who underwent electrocardiogram-gated cardiac computed tomography after TAVR. In the #rotation method, the hat marker of the delivery catheter was adjusted to face the greater curvature of the descending thoracic aorta in the left anterior oblique view. Its orientation was maintained while the system passed through the aortic arch.

Results: In total, 60 and 35 patients underwent TAVR with the #rotation and non-#rotation methods, respectively. A ±15° angle between the native and neo-commissures was more frequent in the #rotation group (p=0.001). Favourable angles and appropriate frame orientation for access to the left coronary artery were significantly more frequent in the #rotation group than in the non-#rotation group (p<0.001 and p=0.001). Although the #rotation method showed a higher rate of favourable angles and frames in the right coronary artery, statistically significant differences were not found.

Conclusions: The #rotation method is useful for improving commissural post alignment in TAVR with Evolut devices, especially in the ostium of the left coronary artery.